MEDICARE: PROFESSIONAL SPORTSCARE & REHAB, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1144687419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL SPORTSCARE & REHAB, LLC

Provider Business Mailing Address
First Line	:	2122 YORK RD STE 300
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1925
Country	:	US
Telephone Number	:	252-248-3313
Fax Number	:

Provider Business Practice Location Address
First Line	:	745 SOLOMONS ISLAND RD N
Second Line	:
City	:	PRINCE FREDERICK
State	:	MD
Zip	:	20678-3916
Country	:	US
Telephone Number	:	410-885-4710
Fax Number	:	410-885-4709

Authorized Official
Title or Position	:	MANAGER, CREDENTIALING
Name	:	ALLISON KEEL
Credential	:
Telephone Number	:	989-250-8385

Provider Enumeration Date	:	01/18/2016
Last Update Date	:	02/11/2026

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